Vietnam Veterans of America
Lawrence G. Brown Memorial Chapter #896, Endicott,NY
Membership is open to U.S. armed forces veterans who served on active duty (for other than training purposes) in the Republic
of Vietnam between February 28, 1961 and May 7, 1975, or in any duty location between August 5, 1964 and May 7, 1975.
 

APPLICATION FOR MEMBERSHIP

ATTENTION: New members and new life members You must submit a copy of
your DD Form - 214 form along with this application and dues payment.

Name:
            

 
Address:  
 
City:   State:   Zip:  
Home Phone: Work Phone:  
E-Mail Address:    
Date of Birth: Sex:  

Optional:
Chapter No. 896  Sponsor:  

___ I am already a VVA member and want to become a life member.
My VVA Member number is ______________ .

Type of Membership:
  
      Life Member-Ages 49 and Under : $250
  Individual Member -1 year: $20   Life Member-Ages 50-55: $225
  Individual Member- 3 years: $50   Life Member-Ages 56-60: $200
      Life Member-Ages 61-65: $175
 

Life Member-Ages 66+: $150
 

Optional Time Payment plan- $50 down, $25/month

 

Payment Method:
       
Check
       
Money Order
    Signature:  



 
Return your completed application, payment, and a copy of your DD Form-214 to:


Vietnam Veterans of America
Lawrence G. Brown Memorial Chapter 896
1405 Minor Circle
Endicott, NY 13760-1325